| NPI | 1326175597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA 146475) |
| Additional Taxonomies | 174400000X Specialist (Licence: MT 7551) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2017-01-04 |